Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT j <br /> --------- -- ---- -----•--..-. .......--•......... <br /> Permit No. <br /> (Complete in Triplicate) �. <br />.................................. ..................... This Permit Expires 1 Year From Date issued <br /> Date Issued .l..e?' <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> descrito_This ppli gtion is made in compliance with County Ordinance No. 549 and, existing Rules and Regulations: <br /> �� / - ��� <br /> JJ/8 A R SS LOCATION .....-. - ---- � 1' �- !. A ..... : *,e.•-•...............CENSUS TRACT ....--........:....... <br /> .... <br /> Owner's Name 4.4./._e .................. ....:........Phone .................................... <br /> Address -------ze,Y. .............................................. ........... -E /"i�( ...-... �1�/. = <br /> .. .. City ..........Contractor's Name ...License # s �° Phone fix/ .:.c l.Z...... <br /> .-�'�'f-Fr'_-.-:. -,�'��;�-.r`.:..............-------------•--............. <br /> Installation will serve: Residence ❑Apartment House C] Commercial❑Trailer Court <br /> Motel ❑Other -------------------------------•---•.................................. <br /> Number of livingunits...-A.... Number of bedrooms __. _. '� <br /> __._.Garbage Grinder ./�!`.�__ Lot Size �:��--�i-4.:.............. <br /> Water Supply: Public System and name .Lfr0l. .--___•-------------------•_____-- .............Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat[] Sandy Loam ❑. 'Clay Loam ❑ <br /> Hardpan ❑ Adobe 21 Fill Material _...-....... If yes,type _------_------------ ----_-_ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) v` <br /> NEW INSTALLATION: - (No.septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT' { ] SEPTIC TANK f ] Size.................................................. Liquid Depth ..._._...._. ............. <br /> Capacity ..__.:............... Type .................... Material.----------_------__ No. Com artments <br /> Distance to nearest: Well ...................:................Foundation ...................... Prop. Line ...................... <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of each line............................ Total Length ....-..--_ ................. <br /> 'D' Box ------------ Type Filter Material ..:.Depth Filter Material .................. <br /> Di tante to nearest: Well ........................ Foundation -..-.--_._-•--•--._..... Property Line <br /> SEEPAGE PIT Depth .................... Diameter ... ............ Number -----------_-------------- Rock Filled Yes ❑ No C3 <br /> w. <br /> Water Table Depth .......Rock Size ........ <br /> Distance to nearest: Well ..... ................... . ...Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION,(Prey.,Sanitation Permit#' ............................................ Date ..................................) <br /> Septic Tank (Specify Requirements) ...............--------- --------...................................__.._..........: ..--` .................. <br /> Disposal Field (Specify Requirements} •-- ..(.. ................. C , ....... ' F ( �•.��',f • ' <br /> ti^ <br /> ------------------------------••------------...._.....-._...-...-.......-. <br /> ..................•--............................................................. ................•..........................------------------------------------------------- ------- <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Homo owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ............:........' Owner <br /> y ............. . �. , ... .-...- .... Title ----- •- <br /> (If rr than owner) <br /> f ' OR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .. - ...d,� ------•••••----••-----•••..................••...... DATE ./.. 5.. .. .yY.-............... <br /> BUILDING PERMIT-ISSUED ......I......... --•-----•----•• ...................... ..............DATE ...............I........................... <br /> ADDITIONAL COMMENTS ........................ ............... - <br /> ......-• - ----------------••-•---•--.-•••----•--•-.....--•--........-.........-................ <br /> --•••------- - ------------- --- •-- -................................................ <br /> Finalins ection by: ..--•---------�••••......._ -- --------- ........................... ............................................Date <br /> �.. .-.... <br /> SAN JOAQUIN LO L HEALTH. DISTRICT <br /> E. H. 1-3 24 1-'68 Rev. 5M 7/72 3 �K <br />